Improving Health and Saving Money by Fixing Overuse and Underuse of Medical Care

Both overuse and underuse of health and
medical services are extensive
problems but happen side-by-side in different countries, within
countries, among populations, within institutions, and even for a single
person.

Improving Health and Saving Money by Fixing Overuse and Underuse of Medical Care

Launched today by The Lancet, the 'Right Care Series' features
major commentaries by Vikas Saini (Lown Institute, Boston), Adam
Elshaug (University of Sydney), Paul Glasziou (Bond University), Don
Berwick (Institute for Healthcare Improvement, Cambridge, MA) and others
who examine the areas and extent of overuse and underuse of health and
medical services.

‘The landmark Lancet Series on overuse and underuse of health care and medical services constitutes a call-to-arms to improve health care globally by better matching care to needs, and practice to science.’

The series defines overuse as "the provision of medical services
that are more likely to cause harm than good", and underuse as "the
failure to use effective and affordable medical interventions".

"This situation offers an enormous, and currently poorly recognized,
opportunity to tackle underuse and overuse together to achieve the
right care for health and wellbeing, and a sustainable health care
system," said Professor Paul Glasziou of Bond University.

Australian lead author, Professor Adam Elshaug of the University of
Sydney added: "All countries including Australia are struggling with
spiraling costs of health care, with increasing prospects of rationing
and restricting services - which would increase inequality and worsen
our health outcomes. It's tempting to think that rich countries will
have overuse problems and poor countries will have underuse problems,
but it's not that simple. In Australia, the U.S. and elsewhere, you
actually see both problems - worthwhile, cost-effective interventions
that are vastly underused, and high-cost effective services of little or
no value that are commonplace."

Professor Elshaug also points out the growing relevance of this
issue within the Asia-Pacific region, as more developing economies
through Asia strive for universal health care (UHC). He states,
"ensuring that everyone within a society has equitable access to some
agreed basic level of affordable, effective and wanted health care
services is a moral imperative now formally recognized by the United
Nations.

However, as we state in our Series of papers, the journey to
UHC will - and ought to - focus more of the world's attention towards
redressing low-value care as an urgent task. The fundamental ethical,
economic, and political challenge arising from poor care is that as long
as funds - including tax-payers funds via Medicare - are devoted to
low-value care, the potential for health gain elsewhere in the system is
unnecessarily restricted."

In commenting on the Series, Professor Don Berwick, Director of the Institute for Health Improvement, said: "This landmark Lancet
Series on overuse and underuse constitutes a call-to-arms to improve
health care globally by better matching care to needs, and practice to
science. Reducing unwarranted, useless, and, therefore, harmful care is
an important part of that agenda."

Key messages of the series are:

- Overuse and underuse coexist within populations, within systems, and even within patients around the world.- Underuse of proven medical care and overuse of unproven
services causes suffering to millions of people around the world. The
costs are serious: physical, psychological, and social harms for
patients and wasteful misallocation of resources for society.- Because most care falls in a grey zone in which
benefits and harms are not clear, attention to preferences of patients
is essential.- Over and underuse are symptoms of a health-care system
that does not reflect the ethics of medicine. They undermine the
capacity of countries to achieve sustainable universal health coverage
and to ensure that health care is a human right. Action is possible and
necessary.

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